ARTICLE

Effects of the Seattle Social Development Project

on Sexual Behavior, Pregnancy, Birth, and Sexually
Transmitted Disease Outcomes by Age 21 Years
Heather S. Lonczak, PhD; Robert D. Abbott, PhD; J. David Hawkins, PhD;
Rick Kosterman, PhD; Richard F. Catalano, PhD

Objective: To examine the long-term effects of the full
Seattle Social Development Project intervention on
sexual behavior and associated outcomes assessed at
age 21 years.
Design: Nonrandomized controlled trial with long-
term follow-up.
Setting: Public elementary schools serving children from
high-crime areas in Seattle, Wash.
Participants: Ninety-three percent of the fifth-grade stu-
dents enrolled in either the full-intervention or control
group were successfully interviewed at age 21 years
(n=144 [full intervention] and n = 205 [control]).
Interventions: In-service teacher training, parenting
classes, and social competence training for children.
Main Outcome Measures: Self-report measures of all
outcomes.
Results: The full-intervention group reported signifi-
cantly fewer sexual partners and experienced a margin-
ally reduced risk for initiating intercourse by age 21 years
as compared with the control group. Among females, treat-
ment group status was associated with a significantly re-
duced likelihood of both becoming pregnant and expe-
riencing a birth by age 21 years. Among single individuals,
a significantly increased probability of condom use dur-
ing last intercourse was predicted by full-intervention
group membership; a significant ethnic group ⫻ inter-
vention group interaction indicated that after control-
ling for socioeconomic status, single African Americans
were especially responsive to the intervention in terms
of this outcome. Finally, a significant treatment ⫻ eth-
nic group interaction indicated that among African Ameri-
cans, being in the full-intervention group predicted a re-
duced probability of contracting a sexually transmitted
disease by age 21 years.
Conclusion: A theory-based social development pro-
gram that promotes academic success, social compe-
tence, and bonding to school during the elementary grades
can prevent risky sexual practices and adverse health con-
sequences in early adulthood.
Arch Pediatr Adolesc Med. 2002;156:438-447

From the Schools of Social
Work (Dr Lonczak) and
Educational Psychology
(Dr Abbott), and the Social
Development Research Group
(Drs Hawkins, Kosterman, and
Catalano), University of
Washington, Seattle.
T
HE OFTEN devastating and
life-changing implications of
early sexual activity under-
score the importance of pre-
vention-focused research.
For several decades, early pregnancy has
maintained its standing as one of the United
States’ most persistent and troublesome
social problems. With more than 900000
teenagers becoming pregnant each year,1
adolescent pregnancy rates in the United
States have continued to surpass those of
almost all other developed countries.2 Each
year, 10% of American females aged 15 to
19 years will become pregnant, and roughly
half of them will give birth.3 Adolescent
motherhood has been associated with aca-
demic deficits,4-6 poor socioeconomic out-
comes,7,8 repeat pregnancy,9,10 and single-
parent status.11,12
Sexually transmitted disease (STD) is
another threat to the health and well-
being of American young people. Adoles-
cents and adults younger than 25 years ex-
perience STD in far greater numbers than
For editorial comment
see page 429
older adults. For example, excluding hu-
man immunodeficiency virus (HIV), two
thirds of the 12 million cases of STD re-
ported annually occur among individuals
younger than 25 years.13 Among the nega-
tive consequences of STD are cancer, ec-
topic pregnancy, perinatal infection, chronic
pain, sterility, and death.14
Pregnancy and STD outcomes occur
as a function of early intercourse onset, mul-
tiple sexual partners, and lack of contra-

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 PARTICIPANTS AND METHODS
DESIGN AND DATA COLLECTION
The study of intervention effects is part of a longitudinal panel
study of all consenting fifth-grade students (n=808) in 18
public schools serving high-crime areas of Seattle, Wash. All
schools contacted by SSDP staff chose to participate in the
study. In 1981, an intervention was initiated among first-
grade students in 8 public schools, and in 1985, when these
children entered fifth grade, the study was expanded to in-
clude fifth-grade students in 10 additional schools. Schools
were assigned nonrandomly to conditions in the fall of 1985,
and thereafter, all fifth-grade students in each school par-
ticipated in the same interventions. New schools added for
the panel study were matched to the intervention schools
with respect to grades served and inclusion of students drawn
from high-crime neighborhoods. Schools added for the panel
study were assigned to conditions to achieve balanced num-
bers across conditions. This resulted in a nonrandomized con-
trolled trial with 4 conditions. The full-intervention group
(n=156) received the intervention described earlier from
grades 1 through 6 if they remained in intervention schools,
with an average dose of 3 years. The late intervention group
(n=267) received the intervention during grades 5 and 6 only
and is not discussed in this article because no significant ef-
fects of the late intervention on sexual behavior outcomes
were found at age 18 years. The “parent training only” group
(n=141) was offered only the “Preparing for the Drug (Free)
Years” curriculum during grades 5 and 6 and is not dis-
cussed in this article. The control group (n=220) received
no intervention. (There was also a small group of individu-
als who could not be classified into any of these groups
[n = 24]). In sum, parents of 76% of fifth-grade students
(N=808) in 18 Seattle public schools consented to partici-
pate in the longitudinal follow-up study; this group consti-
tutes the SSDP sample. Of those 808, 376 were assigned to
the full-intervention and control groups discussed in the pres-
ent article. At age 21 years, 349 of those 376 were success-
fully interviewed and constitute the sample analyzed here.
Research staff interviewed participants in the spring
of 1996 when respondents were age 21 years. Due to item
ceptive use.15-17 Individuals who begin having inter-
course at a young age are at an increased risk for pregnancy
and STD because they tend to have more sexual partners
and are less likely to use contraception.18-21 Additionally,
given their relatively increased susceptibility to some patho-
gens, females are particularly at risk for acquiring certain
STDs.22
PREVENTION
While program evaluations have shown improved results
in the past several years (Kirby23 provides a comprehen-
sive review), there is still much work to be done in the pre-
vention of risky sexual behavior. Among the program types
that have demonstrated effectiveness in reducing youth
sexual behavior–related adverse adverse outcomes are com-
petency-promoting, positive youth development pro-
grams.23 These programs attempt to foster behavioral, so-
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sensitivity, the sex questionnaire was completed as a sepa-
rate paper-and-pencil instrument and placed in a sealed en-
velope by the respondent. All phases of the study were ap-
proved by the Human Subjects Review Committee at the
University of Washington. Participants were informed about
the nature of the interviews and provided consent prior to
participation in the study at age 21 years.
SAMPLE
Because an earlier study66 found significant effects on sexual
behavior outcomes at age 18 years only for the full-intervention
group, this article compares only the full-intervention group
with the control group to test the durability of these findings
in early adulthood. Of the 376 youths in these 2 conditions,
27werenotinterviewedatage21years.Thisresultedinasample
size of 349, with 144 participants from the full-intervention
group and 205 from the control group.
INTERNAL VALIDITY
The SSDP has had consistently high sample-retention rates,
with 93% of individuals in the full-intervention group and
control group successfully interviewed at age 21 years. Prior
analyses of these groups66 found no significant differences in
gender distribution, race distribution (white vs nonwhite),
poverty (free lunch eligibility during grades 5, 6, or 7), pro-
portion from single-parent homes (during grade 5), mean years
of parents’ education (during grade 5), mean years living in
Seattle (by grade 6), or mean number of residences lived in
(from age 5 to 14 years) between the full-intervention group
and the control group. Hawkins et al66 found no significant
attrition effects or differences in treatment group distribu-
tion at age 18 years by gender, race, or poverty. Analyses of
possible effects of attrition on the internal validity of results
at age 21 years were conducted on the following variables:
gender, race or ethnicity (white vs nonwhite), poverty (free
lunch eligibility), family size (a continuous measure of the
number of people currently living in the home), mother’s edu-
cational level (a continuous measure of mother’s highest level
of completed schooling), church attendance (an ordinal
Continued on next page
cial, emotional, and cognitive competency to promote
healthy adjustment in multiple settings. Examples of ef-
fective positive youth development programs include the
High/Scope Perry Preschool Program24 (an enriched pre-
school program promoting early prosocial development
among high-risk children), the Quantum Opportunities Pro-
gram25 (which used financial incentives, tutoring, mentor-
ing, and other strategies to promote academic compe-
tence among high school students), and Teen Outreach26
(which promoted prosocial norms, involvement, bond-
ing and self-efficacy by involving tenth graders in commu-
nity-based volunteer activities and weekly classroom
discussions). Each of these programs resulted in signifi-
cantly fewer adolescent pregnancies among intervention
group members as compared with controls, despite the fact
that none of them focused directly on sexual behavior. Ad-
ditionally, the Children’s Aid Society Carrera Program27 took
a broad approach to pregnancy prevention by including a
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 measure of yearly church attendance frequency), and age
at the survey. These analyses (Table 2) found no signifi-
cant differences in the distribution into treatment groups
among those retained in the 21-year-old sample for any of
the variables examined.
MEASURES
Participants’ sexual activity was assessed at the age-21 sur-
vey by the following question: “Have you ever had sex with
another person?” As defined in the sex questionnaire in-
structions, the terms “sex” and “sexual intercourse” refer to
oral, vaginal, and anal sex. The 2 dichotomous measures of
condom use were assessed by the following questions: “The
first time you had sexual intercourse did you use latex pro-
tection such as condoms or gloves?” and “The last time you
had sexual intercourse did you use latex protection such as
condoms or gloves?” Past-year condom use was measured
by the following question: “In the past year, how much of
the time was latex protection used when you had sexual in-
tercourse?” Response choices were as follows: “none of the
time=1,” “less than half of the time=2,” “about half of the
time=3,” “most of the time=4,” and “always=5.” Note that
because condom use outcomes pertain only to individuals
who had had sex by age 21 years, sample sizes are smaller
for these variables. Further, aside from the “condom use dur-
ing first intercourse” measure, condom-use outcomes in-
clude only individuals who were single (neither married nor
living with a partner) at age 21 years. The relative lack of
monogamy among single individuals places this group at
greater risk for engaging in risky sexual behavior and, there-
fore, experiencing or causing an unplanned pregnancy or an
STD. Further, because single and nonsingle individuals might
have distinct motivations for condom-use or nonuse (eg, lack
of condom use among nonsingle people might be due to the
desire to get pregnant), combining these groups is inappro-
priate. Thus, samples for these condom-use measures are
smaller because they are limited to single people. Age of sexual
onset was assessed by the following open-ended question:
“How old were you the first time you had sex?” Four indi-
viduals reported their ages at sexual intercourse as before
the age of 9 years; they were excluded from analyses exam-
ining age of sexual debut for 2 reasons. First, persons younger
work-relatedcomponent(eg,stipends),aneducationalcom-
ponent (eg, tutoring), family life and sex education, and in-
dividual sports. Relative to a control group, adolescent fe-
males who participated in this program experienced sig-
nificant reductions in pregnancies and births, were signifi-
cantly less likely to have initiated sex, and were significantly
more likely to use contraception.27 This program demon-
strates that a comprehensive prevention approach target-
ing multiple domains of behavior can result in significant
reductions in adolescent sexual risk taking and its associ-
ated outcomes. Evaluations have also identified the follow-
ing as important components of effective pregnancy pre-
vention programs: a theoretical foundation,28-31 a reasonable
treatment duration or dose,28 and the inclusion of youths
who have not yet initiated sexual activity.32,33
Studies of the antecedents of sexual behavior out-
comes can inform prevention efforts by identifying tar-
gets for preventive interventions. For example, analysis of
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than 9 years would have received only a portion of the in-
tervention prior to initiating sex; and second, such early ages
at sexual intercourse may represent nonconsensual inter-
course. Sexual partners were assessed by the following ques-
tion: “How many sexual partners have you had in your life-
time?” Response choices were as follows: 0, 1, 2, 3, 4, 5, or
6 or more. Finally, the dichotomous measures of STD, preg-
nancy, and birth were as follows, respectively: “Have you ever
been told by a nurse or doctor that you had a sexually trans-
mitted disease (STD or VD [venereal disease], other than HIV/
AIDS [human immunodeficiency virus/acquired immuno-
deficiency virus]), such as gonorrhea, genital warts,
chlamydia, trich, herpes, or syphilis?”; “Have you ever been
pregnant?” (females) or “Have you ever gotten a woman preg-
nant?” (males); and “Have you ever had a baby?” (females)
or “Have you ever fathered a baby?” (males).
ANALYSIS
To evaluate the intervention, logistic regression was used to
examine dichotomous outcomes, linear regression was used
to examine continuous outcomes, and survival analysis was
used to evaluate effects on age of sexual onset. Each model
was first run to examine whether, with poverty statistically
controlled, there were interaction effects between treat-
ment group, and African American ethnic group vs all re-
maining ethnic groups combined. Poverty was measured by
school record data indicating whether or not study chil-
dren participated in the federal free or reduced school lunch
program in the fifth, sixth, or seventh grades. African Ameri-
cans were compared with other ethnic groups because, with-
out intervention, African American young people have been
reported as having disproportionately high rates of sexual
activity,67-69 pregnancies and births,1,67 and STD1,17,70 rela-
tive to other ethnic groups. For example, African American
males have been reported as 9 times more likely than white
males to have initiated sexual intercourse by age 13 years.71
Interaction terms were also tested for treatment group ⫻ gen-
der. Because they represent distinct outcomes for males and
females, pregnancy and birth outcomes were analyzed sepa-
rately by gender. Finally, to provide a more powerful test of
the effect of treatment on age of sexual debut, age of sexual
onset was examined using Cox regression analysis.
the National Longitudinal Study of Adolescent Health re-
ported both parent/family bonding and school bonding to
be associated with a delayed sexual debut, and shared ac-
tivities with parents to be associated with a reduced risk
of adolescent pregnancy.34 Other familial factors associ-
ated with lower rates of risky sexual behavior include pa-
rental monitoring and supervision, rule-setting about dat-
ing, and parent-child relationships characterized by support
and open communication.35-38 Additionally, peer norms have
been found to affect the timing and nature of adolescent
sexual behavior.16,39-41 Finally, academic failure has been
found to be a strong predictor of risky sexual behavior and
teen pregnancy.28,29,42 Adolescents who do well in school
and have relatively high educational aspirations engage in
less risky sexual behavior36 and are less likely to become
teen parents.31,38,43-45 Consequently, empowering families,
addressing peer influences, and promoting academic com-
petence are important goals for prevention programs aimed
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at reducing risky sexual behavior and its consequences
among young people.
THE SEATTLE SOCIAL DEVELOPMENT PROJECT
The Seattle Social Development Project (SSDP) included
an intervention nested within a longitudinal panel study.
The SSDP intervention was guided by the social develop-
ment model,46 a theory of behavior that integrates ele-
ments of social control,47 social learning,48 and differential
association theories.49,50 The social development model hy-
pothesizes that families and schools that provide youths
with opportunities for active, contributing involvement; that
ensure that youths develop competency or skills for par-
ticipation; and that consistently reinforce effort and skill-
ful participation in school and family, produce strong bonds
between young people and these social units. Following
control theory, the social development model hypoth-
esizes that strong bonds to school and family protect youths
against socially unacceptable behaviors, including early
sexual intercourse and unprotected sexual behavior.
Based on the social development model,46,51 the SSDP
intervention sought to promote bonding to school and
family by enhancing opportunities and reinforcement for
children’s active involvement in family and school, and
by strengthening children’s social competencies. The in-
tervention included the following 3 components: teacher
training, child social and emotional skill development,
and parent training. These are described further in
Table 1.
Each year during the elementary grades (grades 1
through 6), teachers in the intervention classrooms re-
ceived 5 days of in-service training in a package of instruc-
tional methods52 with 3 major components: proactive class-
room management,53 interactive teaching,54 and cooperative
learning.55 Teachers of control students did not receive train-
ing in instructional or classroom management skills from
the project. Both intervention and control teachers were
observed for 50 minutes on 2 different days during fall and
spring each year using the Interactive Teaching Map.56,57
This structured observation system provides assessment of
the degree to which teachers are using the proactive class-
room management, interactive teaching, and cooperative
learning methods outlined in Table 1. These controlled ob-
servations indicated greater use of the targeted instruc-
tional and management methods in the intervention class-
rooms than in the control classrooms. Effects of
implementation of the projects’ instructional methods on
students’ social development and achievement, and me-
diators of the sexual behavior–related outcomes investi-
gated here, have been reported elsewhere.58
Second, prior to the school year, first-grade teachers
in the full-intervention group received instruction in the
use of a cognitive and social skills training curriculum, In-
terpersonal Cognitive Problem Solving,59,60 which teaches
children the skills to identify a problem, generate alter-
native solutions, and choose and implement the chosen
solution. This curriculum sought to develop children’s skills
for involvement in cooperative learning groups and other
social activities, without resorting to aggressive or other
problem behaviors. Additionally, during grade 6, a study
consultant provided students in the full-intervention group
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Table 1. Seattle Social Development Project Interventions
Component 1: teacher training in classroom instruction and management
Proactive classroom management
Establish consistent classroom expectations and routines at the
beginning of the year
Give clear, explicit instructions for behavior
Recognize and reward desirable student behavior and efforts to
comply
Use methods that keep minor classroom disruptions from
interrupting instruction
Interactive teaching
Assess and activate foundation knowledge before teaching
Teach to explicit learning objectives
Model skills to be learned
Frequently monitor student comprehension as material is presented
Reteach material when necessary
Cooperative learning
Involve small teams of students of different ability levels and
backgrounds as learning partners
Provide recognition to teams for academic improvement of
individual members over past performance
Component 2: child social and emotional skill development
Interpersonal problem-solving skills
Communication
Decision making
Negotiation
Conflict resolution
Refusal skills
Recognize social influences to engage in problem behaviors
Identify consequences of problem behaviors
Generate and suggest alternatives
Invite peer(s) to join in alternatives
Component 3: parent training
Behavior management skills
Observe and pinpoint desirable and undesirable child behaviors
Teach expectations for behaviors
Provide consistent positive reinforcement for desired behavior
Provide consistent and moderate consequences for undesired
behaviors
Academic support skills
Initiate conversation with teachers about children’s learning
Help children develop reading and math skills
Create a home environment supporting of learning
Skills to reduce risks for drug use
Establish a family policy on drug use
Practice refusal skills with children
Use self-control skills to reduce family conflict
Create new opportunities in the family for children to contribute and
learn
with 4 hours of training in skills to recognize and resist
social influences to engage in problem behaviors and to
develop positive alternatives to stay out of trouble while
maintaining friendships.61 Children in the intervention
group, therefore, received child social and emotional skills
training during grades 1 and 6, and teacher interventions
during all grades from 1 through 6.
Third, parent training was offered on a voluntary ba-
sis to the parents or adult caretakers of children in inter-
ventionclassrooms.Childbehaviormanagementskillstrain-
ing was offered when children were in the first and second
grades through a 7-session curriculum, “Catch ‘Em Being
Good,”62 grounded in the work of Patterson et al.63 In the
spring of second grade and again in the third grade, parents
were offered a 4-session curriculum, “How to Help Your
Child Succeed in School,”64 to strengthen their skills for sup-
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 Table 2. Analyses of Attrition and Intervention Group Distribution

Original Sample Analysis Sample

Control Full-Intervention Control Full-Intervention

Group Group Total No. Group Group Total No.
Factor* (n = 220) (n = 156) (376) (n = 205) (n = 144) (349) Internal Validity†
Gender (male), % 54 51 376 52 51 349 ␹21 = 0.035 (P = .85)
Race/ethnicity (white), % 45 47 376 46 47 349 ␹21 = 0.026 (P = .87)
Poverty, % 43 41 360 42 42 349 ␹21 = 0.128 (P = .72)
Mean family size 4.5 4.8 337 4.5 4.8 315 t 313 = 1.50 (P = .13)
Mother’s education, mean 4.1 4.3 328 4.2 4.4 307 t 305 = 1.52 (P = .13)
Church attendance, mean 2.5 2.5 358 2.5 2.6 335 t 333 = 0.278 (P = .78)
Mean age at age-21 survey, y 21.4 21.3 376 21.3 21.3 349 t 347 = −1.09 (P = .28)

*Poverty refers to participation in the federal free or reduced-price school lunch program between the fifth and seventh grades; mean family size is a continuous
measure of the number of people currently living in the home; mother’s education, the highest level of education mothers had completed by the time their
participation child was in the eighth grade (1 = some or all of elementary school, 2 = some or all of middle school, 3 = some high school, 4 = 4 years of high
school, 5 = some college, 6 = 4 or more years of college,); and church attendance, participants’ typical church attendance (1 = once a year or never; 2 = 2 or 3
times a year; 3 = once or twice a month; 4 = once a week).
†This analysis compares distribution on each factor by treatment condition for those retained in the sample.

portingtheirchildren’sacademicdevelopment.Duringgrades ticipants (9%); living with partner, 52 participants (15%);

5 and 6, parents were offered a 5-session curriculum “Pre-
paring for the Drug (Free) Years,”65 designed to strengthen
their skills to reduce their children’s risks for drug use. Par-
ents of 43% of children in the full-intervention group at-
tended parenting classes. Overall, children in the full-
intervention group received the SSDP intervention for at
least one semester in grade 1, 2, 3, or 4, and for at least one
semester in grade 5 or 6; thus participating in the interven-
tion in both early and late elementary grades.
In summary, the intervention was focused on en-
hancing the socialization processes specified by the so-
cial development model during grades 1 through 6. No
content specific to sexual behavior was provided. The full
intervention, delivered in grades 1 through 6, has dem-
onstrated effects in significantly reducing sexual behav-
ior at age 18 years.66 This article examines the effects of
the full SSDP intervention on sexual behavior (age of
sexual onset, condom use, and sexual partners), preg-
nancy, birth, and STD outcomes at age 21 years.
RESULTS
DESCRIPTIVE STATISTICS
Demographics
Of the 349 full-intervention and control participants with
data at age 21 years, 179 participants (51%) were males and
170 participants (49%) were females. The mean age of par-
ticipants at the time of the fifth-grade survey (fall 1985)
was 10.8 years. At the time of the age-21 survey, partici-
pants’ ages averaged 21.3 years. The distribution by eth-
nic groups was as follows: white, 163 participants (47%);
African American, 89 participants (26%); Asian Ameri-
can, 74 participants (21%); and other ethnic groups, 23 par-
ticipants (7%). Fifty-five percent of the sample had expe-
rienced poverty, as indicated by eligibility for the federal
free lunch program between the fifth and seventh grades.
Marital status at the time of the age-21 interview was as
follows: single, 260 participants (75%); married, 31 par-
and separated/divorced, 6 participants (2%).
Sexual Activity and Age at Onset
Ninety-three percent of the sample were sexually active
by the age-21 assessment. Males reported a significantly
earlier mean age at sexual onset than did females (15.7 years
vs 16.3 years, respectively; P⬍.05). Controlling for pov-
erty, age at sexual initiation also varied significantly
(P⬍.001) by ethnic group, with African Americans re-
porting the earliest mean age at sexual debut (15.1 years)
and Asian Americans reporting the latest (16.8 years). Mean
age at sexual initiation for white participants was 16.0 years,
and for those in other ethnic groups, it was 16.1 years.
Condom Use
Among the 317 individuals who were sexually active by
age 21 years, 67% used condoms the first time they had
sex. Females were significantly more likely to report con-
dom use than were males (74% vs 59%, respectively;
P⬍.01). There were no significant differences in con-
dom use frequencies during first intercourse across eth-
nic groups. Among the 240 single individuals who were
sexually active by age 21 years, 49% used condoms dur-
ing their last intercourse experience. There were no sig-
nificant associations between condom use during last
sexual intercourse and either gender or ethnicity.
Frequency of condom use varied among the 223 cur-
rently sexually active, single individuals in the sample.
Thirty-one percent reported using latex protection “most
of the time” during the past year. There were no signifi-
cant differences in past-year condom use across gender
or ethnicity.
Sexual Partners
Thirty-eight percent of the sample reported having 6 or
more lifetime sexual partners. The average number of sexual
partners reported was 3.9. Males reported significantly more

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 Table 3. Continuous Outcomes by Intervention Group*
Outcome
Mean age at first sexual experience, y
Frequency of condom use in past year among single individuals, No. of uses
No. of lifetime sexual partners†
*All data are presented as mean ± SD (participants); CI indicates confidence interval.
†P⬍.05.
sexual partners than did females (mean number of part-
ners, 4.14 and 3.68, respectively; P⬍.05). Controlling for
poverty, differences in the mean number of sexual part-
ners varied significantly by ethnic group (P⬍.001). Afri-
can Americans reported the highest mean number of sexual
partners (4.5 partners), followed by white participants
(4.1 partners), those in the other ethnic groups (3.8 part-
ners), and finally Asian Americans (2.8 partners).
Pregnancy, Birth, and Sexually Transmitted Disease
Experiencing a pregnancy was common in this sample
(n = 349), with 41% reporting having experienced or
caused a pregnancy by the age-21 survey. Females were
significantly more likely than males to report having ex-
perienced or caused a pregnancy (48% vs 35%, respec-
tively; P⬍.05). Twenty-six percent of the total sample re-
ported experiencing or causing a birth by age 21 years.
Females were significantly more likely to report a birth
than males (33% vs 20%, respectively; P⬍.01). Both of
these gender differences are likely to be influenced by the
relatively greater certainty of females vs males regard-
ing whether pregnancy or birth outcomes have oc-
curred. Fifteen percent of the sample reported having been
diagnosed with STD during their lifetimes. Females were
significantly more likely than males to report a STD di-
agnosis (21% vs 10%, respectively; P⬍.01).
TESTS OF INTERVENTION EFFECTS
Multiple imputation72,73 was used to estimate parameters.
Multiple imputation represents an advancement over stan-
dard missing data strategies such as listwise and pairwise
deletion, which have been shown to systematically un-
derestimate means, variances, and covariances, and thus
to produce biased results.74 In contrast, multiple imputa-
tion techniques have been found to produce maximally
unbiased parameter estimates.73 The NORM multiple im-
putation program75 was used for imputing data. This pro-
gram has been shown to impute unbiased estimates for both
continuous and dichotomous variables.73,75
There was a minimal amount of missing data over-
all, with only 7% of the 5584 data points missing. Three
imputed data sets were created for the present analyses.
As shown by Rubin,72 3 imputations will produce valid
inferences in a data set in which data missing for any vari-
able does not exceed 20%. Condition effect analyses were
performed separately with each of the 3 data sets. Re-
sulting unstandardized ␤ coefficients and standard er-
rors were entered back into the NORM program,75 which
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Mean Difference
Full-Intervention Group Control Group (95% CI)
16.32 ± 2.34 (n = 131) 15.75 ± 2.35 (n = 188) −0.57 (1.09 to −0.09)†
3.28 ± 1.37 (n = 81) 3.12 ± 1.45 (n = 142) −0.16 (−0.55 to 0.23)
3.58 ± 2.20 (n = 144) 4.13 ± 2.05 (n = 205) 0.55 (0.10 to 1.0)†
computed the average of the regression coefficients and
the overall standard errors.
REGRESSION RESULTS
Means by treatment group for each continuous out-
come are displayed in Table 3.
Age at First Sexual Experience
As shown in Table 3, on average, those in the full-
intervention group had their first sexual experience sig-
nificantly later (age 16.3 years) than those in the con-
trol group (age 15.8 years, P⬍.05). Using survival analysis
to examine this outcome, each person was coded as a “1”
(if they initiated intercourse) or a “0” (if they did not ini-
tiate intercourse) at each age between 9 and 22 years.
There were 26 right-censored participants who did not
initiate intercourse by the age-21 survey. Because the Cox
proportional hazards model assumes that the effect of pre-
dictors on hazards is proportional over time (Statistical
Product and Service Solutions 7.0; SPSS Inc, Chicago, Ill),
the question of nonproportional hazards was first exam-
ined by creating a time⫻treatment group interaction vari-
able and testing its significance. The interaction was not
significant (P=.21), indicating that the hazard function
for the treatment groups was proportional over time. The
Cox proportional hazard was marginally significant
(P⬍.10), suggesting that the full intervention produced
a marginally significant effect in reducing the overall rela-
tive risk for engaging in sexual intercourse for the first
time before age 21 years. As shown in Figure 1, the con-
trol group had a higher hazard or cumulative risk for ini-
tiating intercourse than the full-intervention group.
Condom Use
There was not a significant main effect of the full inter-
vention on past-year condom-use frequency among single
individuals at age 21 years. However, after controlling
for poverty, the intervention by ethnic group interac-
tion effect for this outcome was statistically significant
(P⬍.05). The difference in condom use frequency be-
tween the full-intervention group and the control group
was significantly greater for single African Americans than
for single non–African Americans. For example, 50% of
single African Americans in the full-intervention group
reported always using a condom, compared with 12% of
single African Americans in the control group—a differ-
ence of 38%. Among single non–African Americans, the
WWW.ARCHPEDIATRICS.COM
 3.0 50
Full-Intervention Group
Control Group
45 43

2.5 40

35
32
2.0
30

Percentage
Cumulative Hazard Rate

25
1.5
20
16
15
1.0 12 12 12
11 11
10 10
10 9 9
7
6
5
.5

0
0 1 2 3 4 5 6+
No. of Lifetime Sexual Partners
0.0
Full-Intervention Group Figure 2. Percentage of full-intervention and control groups reporting
Control Group lifetime sexual partners.

–.5
8 10 12 14 16 18 20 22 24
Age at First Sexual Intercourse, y
for single non–African Americans. More specifically,
79% of African Americans in the full-treatment group
Figure 1. Cumulative hazard rate for age at first sexual intercourse by reported using a condom during last intercourse, com-
intervention group (N=337). Differences are statistically significant at
P⬍.10. The nonimputed data set was used for figure construction, pared with 36% of African Americans in the control
resulting in a sample size of 337. group. Among non–African Americans, 56% of those in
the full-treatment group reported using a condom dur-
difference in prevalence across intervention groups was ing last intercourse, compared with 47% of those in the
only 9%. control group.

Sexual Partners STD Diagnosis

On average, those in the full-intervention group re- There was not a significant main effect of treatment
ported significantly fewer sexual partners in their life- group on STD diagnosis. However, after controlling for
times than did those in the control group (P⬍.05). As poverty, the ethnic group⫻treatment group interaction
Figure 2 illustrates, the difference between the full- was significant for this outcome (P⬍.01; odds ratio,
intervention group and control group was especially 0.11). Among African Americans, only 7% of those in
pronounced for those reporting the greatest number of the full-intervention group, compared with 34% of
partners, with 43% of the control group reporting 6 or those in the control group, reported being diagnosed
more partners compared with only 32% of the full- with a STD over their lifetimes. Among non–African
intervention group. Americans, 14% of those in the full-intervention group
With regard to dichotomous outcomes, Table 4 reported a STD diagnosis, compared with 11% of those
shows the prevalences of condom use at first and last in- in the control group. Therefore, the difference between
tercourse in addition to lifetime STD for the full- the full-intervention group and the control group was
intervention and control groups. 27% for African Americans, but only 3% for non–
African Americans.
Condom Use
Pregnancy and Birth
There was not a significant main effect of intervention
on condom use during first intercourse. However, those Table 5 displays the proportion of females in each group
in the full-intervention group were significantly more reporting pregnancies and births and the proportion of
likely to report condom use during last intercourse than males in each group reporting having caused pregnan-
those in the control group. Sixty percent of those in the cies or births by age 21 years. Females in the full-
full-intervention group used condoms during last inter- intervention group were significantly less likely both to
course, compared with 44% of those in the control become pregnant (P⬍.05) and to have a baby (P⬍.05)
group. After controlling for poverty, the treatment ⫻ by age 21 years than were females in the control group.
ethnic group interaction was significant for condom use Fifty-six percent of the control females compared with
during last intercourse (P⬍.05; odds ratio, 5.84), indi- 38% of the females in the full-intervention group had been
cating that the difference in last condom use between pregnant by age 21 years, and 40% of the control fe-
the full-intervention group and the control group was males had given birth compared with only 23% of the
significantly greater for single African Americans than females in the full-intervention group. In contrast, as pre-

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 Table 4. Prevalence of Condom Use and STD Outcomes by Intervention Group*

Outcome Full-Intervention Group Control Group Odds Ratio (95% CI)

Condom use during first intercourse
Used condoms 73 (131) 66 (192) 1.42 (0.87-2.30)
Condom use during last intercourse among single individuals
Used condoms 60 (89) 44 (154) 1.88 (1.11-3.19)†
Lifetime STD
Reported STD 13 (144) 18 (205) 0.67 (0.38-1.27)

*All data are presented as percentage (number). STD indicates sexually transmitted disease; CI, confidence interval.
†P⬍.05.

sented in Table 5, the proportion of males in each group

who reported causing a pregnancy or birth did not dif- Table 5. Prevalence of Lifetime Pregnancy and Birth
fer significantly. Outcomes for Females and Males by Intervention Group*

Full-Intervention Control Odds Ratio

COMMENT Outcome Group Group (95% CI)
Females N = 71 N = 99
These analyses provide evidence that a theory-based
Reported a lifetime 38 56 0.50 (0.27-0.93)†
intervention that promoted improved classroom man- pregnancy
agement and instruction, children’s social competence, Reported a lifetime 23 40 0.42 (0.21-0.84)†
and parenting practices during the elementary grades, birth
can reduce potentially dangerous sexual behaviors and Males N = 73 N = 106
their outcomes among young people. By age 21 years, Reported causing 34 36 0.95 (0.51-1.78)
pregnancy
those in the SSDP full-intervention group reported sig- Reported fathering 23 20 1.22 (0.59-2.53)
nificantly fewer lifetime sexual partners. Significantly a child
more single people in the full-intervention group
reported condom use during last intercourse than did *All data are presented as percentages unless otherwise stated. CI indicates
those in the control group. The delay in age of sexual confidence interval.
†P⬍.05.
onset by half a year for those in the full-treatment group
is also a notable finding.
After controlling for socioeconomic status, impor- Despite the scope of the problem, a limited num-
tant treatment ⫻ ethnic group interaction effects were ber of prevention programs have shown significant and
also found. Perhaps most striking is the decreased prob- meaningful effects on sexual behavior and STD out-
ability of contracting an STD by age 21 years among Af- comes.23,28 The present SSDP intervention is quite dif-
rican Americans in the full-intervention group. A greater ferent from many of the interventions that have previ-
proportion of single African Americans in the full- ously been studied for effects on such outcomes. SSDP
intervention group also reported protecting themselves included no sex education. In fact, it involved no dis-
from STD through the use of condoms at last inter- cussion of sex at all. These results support social devel-
course, suggesting that greater use of condoms may be opmental hypotheses regarding the importance of pro-
the mechanism producing this reduction in STD among viding children with opportunities for active involvement
African Americans. in the classroom and family; recognition for participa-
It is also noteworthy that significantly fewer fe- tion in these social units; and the social, emotional, and
males in the full-intervention group than in the control cognitive skills to effectively participate in school and fam-
group had been pregnant and had given birth by age 21 ily during the elementary grades.
years, though the proportions of males in each group who Previously reported findings support the hypoth-
reported causing pregnancy or birth did not differ. The eses that teachers who use better classroom manage-
absence of effects on these outcomes for males may re- ment and instructional practices when children are in the
flect a relative lack of knowledge pertaining to these out- elementary grades strengthen children’s bonds of attach-
comes. However, these gender differences in interven- ment and commitment to school.58 The present results
tion effects may also reflect unique responses to the are consistent with the hypothesis that strengthening chil-
intervention itself. Females may have more to lose from dren’s bonds to prosocial participation will have wide-
becoming pregnant and having children early in life. ranging effects in reducing health-compromising behav-
(There is some evidence, for example, that teen father- iors.66 The present results indicate that enhancing social
hood is less detrimental than teen motherhood in terms development in the elementary school period can re-
of future occupational success).76 Therefore, while the duce risky sexual behavior through age 21 years and can
intervention may have enhanced the commitment of both be of particular benefit for 2 groups who may be espe-
males and females in the full-intervention group to healthy cially at risk for being harmed by those behaviors: fe-
and prosocial lifestyles, for females, avoiding pregnan- males and African Americans.
cies and births may be a more important step toward en- Significant effects were observed for multiple be-
suring the realization of such aspirations. haviors many years after the completion of the interven-

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What This Study Adds
Despite public concern regarding adolescent pregnancy
and STD, there is a paucity of well-evaluated preven-
tion programs effective in preventing risky sexual be-
havior. Although existing evaluations have generated
mixed findings, they have identified important compo-
nents of effective programs, including a theoretical foun-
dation, a reasonable treatment duration or dose, and the
inclusion of youths who have not yet initiated sexual ac-
tivity. In line with these criteria, SSDP included a 6-year
intervention with youth in the elementary grades. Guided
theoretically by the social development model, the SSDP
intervention sought to promote bonding to school and
family by enhancing opportunities and reinforcement for
active involvement of children in family and school, and
by strengthening children’s social competencies. This
evaluation shows that the SSDP intervention had long-
term effects in preventing risky sexual practices and ad-
verse health consequences in early adulthood. It is par-
ticularly noteworthy that these effects were achieved
despite the fact that the SSDP intervention included no
sex education and involved no discussion of sex at all.
tion. These results suggest the importance of social de-
velopmental mechanisms in affecting subsequent sexual
behavior among youth and young adults. They support
the promotion of academic success, social competence,
and social bonding as important for the prevention of risky
sexual behavior and its consequences.
Accepted for publication January 28, 2002.
This research was supported by research grants from
the National Institute on Drug Abuse (1RO1DA09679) and
the Robert Wood Johnson Foundation. Points of view are those
of the authors and are not the official positions of the fund-
ing agencies.
We thank David P. Farrington, PhD, for his com-
ments on drafts of the manuscript.
Corresponding author and reprints: J. David Hawkins,
PhD, Social Development Research Group, 97253rd Ave NE,
Suite 401, Seattle, WA 98115 (e-mail: jdh@u.washington.edu).
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